一种新型的宫腔镜下LNG-IUS宫底固定术的临床应用  

Clinical application of a novel hysteroscopic LNG-IUS fixation at the fundus of uterus

作　　者：陈丽梅[1] 隋龙[1,2] 张宏伟 CHEN Li-mei;SUI Long;ZHANG Hong-wei(Hysteroscopy Centre,Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011,China;Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases,Shanghai 200011,China)

机构地区：[1]复旦大学附属妇产科医院宫腔镜中心,上海200011 [2]上海市女性生殖内分泌相关疾病重点实验室,上海200011

出　　处：《复旦学报（医学版）》2024年第6期997-1001,共5页Fudan University Journal of Medical Sciences

摘　　要：目的探索一种新型的宫腔镜下左炔诺孕酮宫内缓释系统(levonorgestrel-releasing intrauterine system,LNG-IUS)宫底固定术的可行性和临床效果。方法2023年8月至2024年1月在复旦大学附属妇产科医院开展一项前瞻性新型宫腔镜下LNG-IUS宫底固定术,记录患者的临床症状、手术时间、手术并发症、术后LNG-IUS脱落等随访情况。结果共计21例患者纳入研究,平均年龄(37.8±6.8)岁,平均宫深(9.06±0.74)cm。其中8例有LNG-IUS环脱落史(5例宫深>8.5 cm,3例宫深≤8.5 cm,但这3例患者宫颈口较松弛),13例无LNG-IUS脱落史(宫深均>8.5 cm)。平均手术时间(14.0±4.3)min,平均术中出血量(4.5±3.3)mL。所有患者均未发生子宫穿孔、大出血、液体超负荷、术后感染等并发症。术后平均随访(3.2±0.8)个月,未发现LNG-IUS脱落。疼痛评估和月经量均值少于术前,子宫内膜厚度及子宫体积均值小于术前,差异均具有统计学意义。痛经者术后痛经缓解率达95.0%(19/20),月经过多者术后有效率达94.4%(17/18)。主要不良反应为不规律阴道出血,发生率为57.1%(12/21)。结论宫腔镜下LNG-IUS宫底固定术安全有效、操作简单、创伤小、手术时间短、出血少、恢复快,适合于有LNGIUS脱落史、痛经、月经过多或宫腔较大的患者。Objective To explore the feasibility and clinical effects of a novel hysteroscopic levonorgestrel-releasing intrauterine system(LNG-IUS)fixation at the fundus of uterus.Methods From Aug 2023 to Jan 2024,a prospective and novel hysteroscopic LNG-IUS fixation at the fundus of uterus surgery was performed at Obstetrics and Gynecology Hospital,Fudan University.The patient’s clinical symptoms,surgical time,surgical complications,postoperative LNG-IUS expulsion,and other follow-up information were recorded.Results A total of 21 patients were included in this study,with an average age of(37.8±6.8)years old.The average uterine depth was(9.06±0.74)cm.Among them,8 cases had a history of LNG-IUS expulsion(uterine depth>8.5 cm in 5 cases,uterine depth≤8.5 cm in 3 cases,but the cervical canal was relatively loose),and other 13 cases had no history of LNG-IUS expulsion,but the uterine depth was all deeper than 8.5 cm.The average surgical time was(14.0±4.3)minutes,and the average intraoperative blood loss was(4.5±3.3)mL.All patients did not experience complications such as uterine perforation,massive bleeding,fluid overload,or postoperative infection.The average follow-up time after surgery was(3.2±0.8)months,and there was no LNG-IUS expulsion occured.The pain assessment and mean menstrual flow after operation were less than those before operation,and the endometrial thickness and mean uterine volume after operation were lower than those before operation,with statistically significant differences.For patients with dysmenorrhea,the postoperative relief rate was 95.0%(19/20),and for those with excessive menstruation,the postoperative effective rate reached 94.4%(17/18).The main adverse reaction was irregular vaginal bleeding,with an incidence rate of 57.1%(12/21).Conclusion Hysteroscopic LNG-IUS fixation at the fundus of uterus is safe and effective.The procedure is simple,minimally invasive,has a short surgical time,minimal bleeding,and fast recovery.It is suitable for patients with dysmenorrhea,excessive menstruation,o

关 键 词：宫腔镜 痛经 月经过多 子宫腺肌病 左炔诺孕酮宫内缓释系统(LNG-IUS) 

分 类 号：R713.9[医药卫生—妇产科学]